不同剂量氢吗啡酮用于膝关节置换术后硬膜外镇痛的临床观察(1)
摘 要：目的 探討不同预充剂量盐酸氢吗啡酮用于老年患者膝关节置换术后硬膜外自控镇痛的效果，观察不良反应情况，为临床用药提供参考。方法 选择在腰硬联合麻醉下行膝关节置换术的老年患者90例，采用随机数字表法将其分为三组(H1组、H2组及H3)，每组30例。手术在腰硬联合麻醉下完成，术毕行PCEA。手术结束前15 min硬膜外给予负荷剂量，分别为盐酸氢吗啡酮H1组0.1 mg、H2组0.2 mg、H3组0.3 mg，术毕连接镇痛泵，配方均为：氢吗啡酮1 mg+0.1%盐酸罗哌卡因+生理盐水至100 ml，背景输注速度2 ml/h，自控1 ml/次，锁定时间15 min。观察并记录术后个时间点患者的平均动脉压、心率、氧饱和度，镇痛、镇静评分及PCEA 按压次数，记录患者不良反应发生情况。结果 H2、H3组2 h、4 h、6 hVAS 评分明显低于H1组，同时H1组观察到PCA的按压次数明显高于其他两组，差异有统计学意义(P<0.05)，H2组与H3组2 h、4 h、6 hVAS 评分无明显差异，无统计学意义(P>0.05)。恶心呕吐和皮肤瘙痒发生的例数H3组高于H1、H2组。结论 硬膜外注入0.2 mg 氢吗啡酮提供完善的镇痛的同时，恶心、呕吐、皮肤瘙痒等不良反应发生率低，可安全用于老年患者膝关节置换术后硬膜外镇痛。
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关键词：氢吗啡酮；罗哌卡因；硬膜外自控镇痛；膝关节置换术
中图分类号：R614 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.01.030
文章编号：1006-1959(2018)01-0085-03
Clinical Observation of Epidural Analgesia after Knee Arthroplasty with Different Doses of Hydromorphine
HUANG Yan-dong
(Department of Anesthesiology，People's Hospital of Jizhou District，Tianjin 301900，China)
, 百拇医药
Abstract：Objective To investigate the effects of different priming doses of hydromorphone hydrochloride for epidural analgesia in elderly patients after total knee arthroplasty，observe the adverse reaction conditions，to provide reference for clinical medication.Methods 90 elderly patients with lumbar epidural anesthesia for knee arthroplasty were randomly divided into three groups(group H1，group H2 and H3)，30 cases in each group.The surgery under combined spinal epidural anesthesia，postoperative PCEA.15 min before the end of surgery epidural administration of loading dose of hydromorphone hydrochloride，respectively in group H1，0.1 Mg，0.2 mg H2 group，0.3 mg H3 group，postoperative analgesia pump，the formulations were： hydromorphone 1 mg+0.1% ropivacaine hydrochloride+saline to 100 ml，background infusion speed 2 ml/h，controlled 1 ml/time，locking time 15 min. The mean arterial pressure，heart rate，oxygen saturation，analgesia，sedation score and the number of PCEA compression were observed and recorded at different time points after operation.The incidence of adverse reactions in patients was recorded.Results The scores of 2 h， 4 h and 6 hVAS in H2 and H3 groups were significantly lower than those in H1 group.The number of PCA compression in H1 group was significantly higher than that in the other two groups，the difference was statistically significant(P<0.05)，H2 group and H3 group，2h，4h，6 hVAS score had no significant difference，no statistical significance(P>0.05).The number of cases of nausea and vomiting in group H3 and the occurrence of pruritus was higher than H1，H2 group. Conclusion Epidural hydromorphone provides perfect 0.2mg the pain，nausea，vomiting， skin itching and other adverse reaction rate is low，is safe for elderly patients with knee arthroplasty after epidural analgesia., http://www.100md.com(黄艳东)
, http://www.100md.com
关键词：氢吗啡酮；罗哌卡因；硬膜外自控镇痛；膝关节置换术
中图分类号：R614 文献标识码：A DOI：10.3969/j.issn.1006-1959.2018.01.030
文章编号：1006-1959(2018)01-0085-03
Clinical Observation of Epidural Analgesia after Knee Arthroplasty with Different Doses of Hydromorphine
HUANG Yan-dong
(Department of Anesthesiology，People's Hospital of Jizhou District，Tianjin 301900，China)
, 百拇医药
Abstract：Objective To investigate the effects of different priming doses of hydromorphone hydrochloride for epidural analgesia in elderly patients after total knee arthroplasty，observe the adverse reaction conditions，to provide reference for clinical medication.Methods 90 elderly patients with lumbar epidural anesthesia for knee arthroplasty were randomly divided into three groups(group H1，group H2 and H3)，30 cases in each group.The surgery under combined spinal epidural anesthesia，postoperative PCEA.15 min before the end of surgery epidural administration of loading dose of hydromorphone hydrochloride，respectively in group H1，0.1 Mg，0.2 mg H2 group，0.3 mg H3 group，postoperative analgesia pump，the formulations were： hydromorphone 1 mg+0.1% ropivacaine hydrochloride+saline to 100 ml，background infusion speed 2 ml/h，controlled 1 ml/time，locking time 15 min. The mean arterial pressure，heart rate，oxygen saturation，analgesia，sedation score and the number of PCEA compression were observed and recorded at different time points after operation.The incidence of adverse reactions in patients was recorded.Results The scores of 2 h， 4 h and 6 hVAS in H2 and H3 groups were significantly lower than those in H1 group.The number of PCA compression in H1 group was significantly higher than that in the other two groups，the difference was statistically significant(P<0.05)，H2 group and H3 group，2h，4h，6 hVAS score had no significant difference，no statistical significance(P>0.05).The number of cases of nausea and vomiting in group H3 and the occurrence of pruritus was higher than H1，H2 group. Conclusion Epidural hydromorphone provides perfect 0.2mg the pain，nausea，vomiting， skin itching and other adverse reaction rate is low，is safe for elderly patients with knee arthroplasty after epidural analgesia., http://www.100md.com(黄艳东)